Field of the Invention
The present invention relates to access systems for accessing and providing access to the peritoneal cavity via a body cavity accessible through a natural orifice, and methods of performing intra-abdominal surgical procedures through such an access system using an endoscope.
State of the Art
Traditional gallbladder removals are either performed via laparoscopic or open surgery techniques Laparoscopic procedures utilize electrocautery electrodes to dissect the gallbladder. These electrodes remain dangerously hot and may cause damage to adjacent viscera. Moreover, the surgical approach requires a large wound or several holes through the abdominal wall.
The field of gastrointestinal endoscopy has for many years been limited to diagnostic and therapeutic techniques to observe, modify and remove tissues located in the digestive tract. Only recently have there been efforts to expand gastrointestinal endoscopic surgery to within the peritoneal cavity to remove large tissue masses such as the appendix and gallbladder. Generally, in these newer procedures, a natural orifice transluminal endoscopic surgery (NOTES) access system is used to gain access to the peritoneal cavity through the stomach or another natural orifice. However, there are still significant limitations to the techniques for visualizing, manipulating and removing masses of tissue on current NOTES systems. In particular, once the NOTES system is in place, an endoscope is used to navigate instrumentation to the subject tissue for removal. Endoscopes are limited in their maneuverability, generally having only a single axis along which they can be bent to direct instrumentation.
Further, the en bloc removal of large tissue masses, such as the gallbladder, presents numerous problems for current endoscopic tools and techniques. Currently, access to and removal of these types of tissue masses requires tissue separation and dissection that can be particularly difficult from an endoscopic approach. Also, after removal of tissues from the surgical site, current system require extremely skilled closure techniques. These closure techniques can prevent acceptance of such procedures from a large number of even skilled surgeons and also greatly increase the time for completing a procedure and the safety of the patient.